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Personal Assistant Application Form Submission 

Title (required): Mrs. 
Address 2: St mellons 
Town (required): Cardiff 

I confirm that I have the right to work in the UK and am able to prove my eligibility status when required to do so. (required): Yes 

Please read the Job Description carefully before providing information in this Section of the Application Form. Give details of your previous employment or experience which you think would help you to do this job. (required): I have been a carer for a few years now, I have worked in a care home, community care and one-on-one I enjoy doing my job I’m a bubbly person and like to see people happy 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Personal care, taking your time and having patients 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I’m a happy bubbly go lucky person, I like to help people with there needs, keep people company and do things they no longer can 

What is it about PA work which appeals to you? (required): Growing up I was in and out of care homes due to my mum and nana being a carer themselves, I enjoy doing what I do it’s rewarding to see a smile on that person face 

What are your hobbies/interests?: Spending time with my children family & friends. Swimming and netball 

Would you consider a casual position if you are unsuccessful with this job? (required): Yes 

Do you drive? (required): No 
Are you a vehicle owner?  (required): No 
Do you smoke? (required): Yes 

Are you able to undertake training? (required): Yes 

What days/nights are you able to work, or prefer to work?  (required): Days - Monday to Friday 

Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): No 

Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? (required): No/ 

Please provide details if necessary: 

I agree that there is nothing which would prevent me from doing this job. (required): Yes 
I consent to the above (required): Yes 

I agree that the information I provide will be posted to the Dewis CIL PA noticeboard (all personal information will be withheld).: Yes 

What geographical area’s are you able to cover?: Rumney Trowbridge st mellons old st mellons 

How many hours of work can you offer per week?: 16-24 

Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Tuesday PM/Wednesday AM/Wednesday PM/Thursday AM/Thursday PM/Friday AM/Friday PM/ 
Further Information: Pm before half 3